Institutional Issues

2021 ◽  
pp. 111-125
Author(s):  
David A. Gruenewald
Keyword(s):  
Care Plan ◽  
Care Planning ◽  
Term Care ◽  
Institutional Issues ◽  
Decision Making Capacity ◽  
Centered Care ◽  
Wish To Hasten Death ◽  
Hastened Death ◽  
Resident Assessment

Residents with intact decision-making capacity who wish to hasten death by VSED while living in institutional long-term care (LTC) settings may encounter barriers to enacting this choice. LTC facility administrators and clinical staff must balance concerns about resident safety and moral objections to hastened death with support for resident rights and self-determination. Achieving this balance involves careful resident assessment and interdisciplinary care planning to identify and mitigate causes of suffering where possible, along with staff training regarding VSED and rigorous documentation of the care plan and interventions. Involvement of hospice may help to: (1) clarify resident goals; (2) ensure alignment between these goals and the care plan; and (3) support physical, psychosocial, and spiritual care before and during VSED. Resident-centered care planning is facilitated by using a checklist to ensure that all major issues are addressed in these complex LTC situations.

Challenges in implementing an advance care planning programme in long-term care

2016 ◽  
Vol 24 (1) ◽  
pp. 87-99 ◽  
Author(s):  
Ciara McGlade ◽  
Edel Daly ◽  
Joan McCarthy ◽  
Nicola Cornally ◽  
Elizabeth Weathers ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Long Term Care ◽  
Care Plan ◽  
Care Planning ◽  
Life Care ◽  
Term Care ◽  
Advance Care

Background: A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. Research aim: To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care. Research design: This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families. Participants and research context: long-term-care residents in two nursing homes and one community hospital. Ethical considerations: The local research ethics committee granted ethical approval. Findings: Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training. Discussion: The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources. Conclusions: Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice.

Advance Care Planning by Proxy for Residents of Long-Term Care Facilities Who Lack Decision-Making Capacity

2002 ◽  
Vol 50 (4) ◽  
pp. 761-767 ◽  
Author(s):  
Ladislav Volicer ◽  
Michael D. Cantor ◽  
Arthur R. Derse ◽  
Denise Murray Edwards ◽  
Angela M. Prudhomme ◽  
...  
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Long Term Care ◽  
Care Planning ◽  
Term Care ◽  
Decision Making Capacity ◽  
Care Facilities ◽  
Advance Care

Perceived Empowerment, Social Support, and Quality of Life Among Chinese Older Residents in Long-Term Care Facilities

2018 ◽  
Vol 30 (10) ◽  
pp. 1595-1619 ◽  
Author(s):  
Jing Wang ◽  
Junqiao Wang ◽  
Yuling Cao ◽  
Shoumei Jia ◽  
Bei Wu
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Long Term Care ◽  
Care Plan ◽  
Term Care ◽  
Centered Care ◽  
Care Models ◽  
Health Related

Objective: This study examines how older residents’ social support and perceived empowerment are associated with their quality of life (QOL) in long-term care (LTC) facilities in Shanghai, China, controlling for their health-related conditions, facility type, and other socio-demographic characteristics. Method: Using a convenient sampling approach, we selected nine LTC facilities in Shanghai, China. We surveyed 515 older residents from these facilities. Results: Older participants in this study rate their QOL, social support, and perceived empowerment as moderate, and these variables are positively associated with their QOL. Older residents who live in government-owned and private-run LTC facilities are more likely to have a higher level of perceived QOL compared with those living in government-run facilities. Discussion: There is an urgent need to increase staff awareness and capacity to empower older residents, and to engage them in their care plan and delivery. LTC facilities could provide more opportunities for older residents’ social networking within and outside LTC facilities. Improvement of older residents’ QOL is critical in the future development of resident-centered care models in LTC facilities.

Issues of Capacity and Decision-Making in the Context of Delirium

2015 ◽  
Vol 24 (4) ◽  
pp. 140-145
Author(s):  
Kevin R. Patterson
Keyword(s):  
Decision Making ◽  
Patient Autonomy ◽  
Care Setting ◽  
Cognitive Change ◽  
Treatment Team ◽  
Precipitating Factors ◽  
Term Care ◽  
Decision Making Capacity ◽  
Fundamental Consideration

Decision-making capacity is a fundamental consideration in working with patients in a clinical setting. One of the most common conditions affecting decision-making capacity in patients in the inpatient or long-term care setting is a form of acute, transient cognitive change known as delirium. A thorough understanding of delirium — how it can present, its predisposing and precipitating factors, and how it can be managed — will improve a speech-language pathologist's (SLPs) ability to make treatment recommendations, and to advise the treatment team on issues related to communication and patient autonomy.

scholarly journals Assisted Living Administrators’ Approaches to Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 66-66
Author(s):  
Elise Abken ◽  
Alexis Bender ◽  
Ann Vandenberg ◽  
Candace Kemp ◽  
Molly Perkins
Keyword(s):  
Advance Care Planning ◽  
Assisted Living ◽  
Staff Training ◽  
Chronically Ill ◽  
External Support ◽  
Care Plan ◽  
Care Planning ◽  
Term Care ◽  
Advance Care ◽  
Eol Care

Abstract Assisted living (AL) communities are increasingly home to frail, chronically ill older adults who remain until death. State laws mandate that AL facilities request copies of any advance care planning documents residents have and make forms available upon request. Using secondary data from a larger study funded by the National Institute on Aging (R01AG047408) that focuses on end-of-life (EOL) care in AL, this project investigated barriers and facilitators to conducting advance care planning in AL. Data included in-depth interviews (of 86 minute average length) with 20 administrators from 7 facilities around the Atlanta metropolitan area and aggregate data collected from each facility regarding facility, staff, and resident characteristics. Findings from thematic analysis of qualitative data showed that key barriers to planning in AL included lack of staff training and reluctance among administrators and families to discuss advance care planning and EOL care. Important facilitators included periodic follow-up discussions of residents’ wishes, often during care plan meetings, educating families about the importance of planning, and external support for staff training and family education from agencies such as hospice and home health. Three study facilities exceeded state requirements to request and store documents by systematically encouraging residents to complete documentation. These facilities, whose administrators discuss advance care planning and residents’ EOL wishes with residents and families during regular care plan meetings, were more likely to have planning documents on file, demonstrating the potential of long-term care communities, such as AL, to successfully promote advance care planning among residents and their family members.

Sign in / Sign up

Export Citation Format

Share Document